Update on Blood Conservation for Cardiac Surgery

Nalla, Bhanu; Freedman, John; Hare, Gregory M. T.; Mazer, C. David

doi:10.1053/j.jvca.2011.07.024

Cited by 23 publications

(8 citation statements)

References 236 publications

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“…In cardiac surgery, blood can be returned to the patient directly from the cardiotomy suction through the bypass circuit or after washing noncellular matter by the use of a cell-saving device [78]. The cardiotomy suction reservoir has been found to be a major collection chamber for particulate and gaseous microemboli, as well as a source of hemolysis, cellular aggregation, and platelet damage.…”

Section: Optimizing Cardiac Surgical Procedures and Cpb Parametersmentioning

confidence: 99%

Cardiac Surgery-Associated Acute Kidney Injury

Mao

Katz²,

Ariyanon³

et al. 2013

Cardiorenal Med

198

141

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Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common and serious postoperative complication of cardiac surgery requiring cardiopulmonary bypass (CPB), and it is the second most common cause of AKI in the intensive care unit. Although the complication has been associated with the use of CPB, the etiology is likely multifactorial and related to intraoperative and early postoperative management including pharmacologic therapy. To date, very little evidence from randomized trials supporting specific interventions to protect from or prevent AKI in broad cardiac surgery populations has been found. The definition of AKI employed by investigators influences not only the incidence of CSA-AKI, but also the identification of risk variables. The advent of novel biomarkers of kidney injury has the potential to facilitate the subclinical diagnosis of CSA-AKI, the assessment of its severity and prognosis, and the early institution of interventions to prevent or reduce kidney damage. Further studies are needed to determine how to optimize cardiac surgical procedures, CPB parameters, and intraoperative and early postoperative blood pressure and renal blood flow to reduce the risk of CSA-AKI. No pharmacologic strategy has demonstrated clear efficacy in the prevention of CSA-AKI; however, some agents, such as the natriuretic peptide nesiritide and the dopamine agonist fenoldopam, have shown promising results in renoprotection. It remains unclear whether CSA-AKI patients can benefit from the early institution of such pharmacologic agents or the early initiation of renal replacement therapy.

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Section: Optimizing Cardiac Surgical Procedures and Cpb Parametersmentioning

confidence: 99%

Cardiac Surgery-Associated Acute Kidney Injury

Mao

Katz²,

Ariyanon³

et al. 2013

Cardiorenal Med

198

141

View full text Add to dashboard Cite

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“…Moreover, substantial variation in transfusion practices among centers remains (9). Only recently has investigation begun regarding the optimal balance between the risks of anemia – an independent risk factor for morbidity and mortality after cardiac surgery – and those associated with RBC transfusion (10, 11). …”

Section: Introductionmentioning

confidence: 99%

Blood Transfusion and Infection After Cardiac Surgery

Horvath

Acker

Chang

et al. 2013

The Annals of Thoracic Surgery

269

182

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Cardiac surgery is the largest consumer of blood products in medicine; although believed life saving, transfusion carries substantial adverse risks. This study characterizes the relationship between transfusion and risk of major infection after cardiac surgery. 5,158 adults were prospectively enrolled to assess infections after cardiac surgery. The most common procedures were isolated coronary artery bypass grafting (31%) and isolated valve surgery (30%); 19% were reoperations. Infections were adjudicated by independent infectious disease experts. Multivariable Cox modeling was used to assess the independent effect of blood and platelet transfusions on major infections within 60±5 days of surgery. Red blood cells (RBCs) and platelets were transfused in 48% and 31% of patients, respectively. Each RBC unit transfused was associated with a 29% increase in crude risk of major infection (P<0.001). Among RBC recipients, the most common infections were pneumonia (3.6%) and bloodstream infections (2%). Risk factors for infection included postoperative RBC units transfused, longer duration of surgery, and transplant or ventricular assist device implantation, in addition to chronic obstructive pulmonary disease, heart failure, and elevated preoperative creatinine. Platelet transfusion decreased the risk of infection (P=.02). Greater attention to management practices that limit RBC use, including cell salvage, small priming volumes, vacuum-assisted venous return with rapid autologous priming, and ultrafiltration, and pre- and intraoperative measures to elevate hematocrit could potentially reduce occurrence of major postoperative infections.

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“…Recommendations suggested by the STS task force 1 such as identification and management of preoperative antiplatelet and anticoagulant drug therapy, autologous blood preservation in operating room, use of cell-saver circuits, minimized CPB circuits, normovolemic hemodilution, modified ultrafiltration, and use of fibrinolytic agents are routinely practiced in the operating rooms. 20 Additional blood conservation measures described in the literature include erythropoietin and iron supplementation for patients with low preoperative hematocrit, 21 autologous blood donation, 22 and desmopressin (DDAVP) for patients with platelet dysfunction. Another opportunity to reduce blood transfusions is to increase the threshold for RBC transfusion on CPB; however, it is to be noted that there is no well-defined safe low hematocrit on CPB.…”

Section: Discussionmentioning

confidence: 99%

Blood Product Utilization with Left Ventricular Assist Device Implantation: A Decade of Statewide Data

et al. 2016

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Blood transfusion rates with cardiac surgery over time have decreased, this trend has not been examined for patients undergoing left ventricular assist device (LVAD) implantation. We investigated blood transfusion trends with LVAD implantation in a statewide database. Between July 2004 and June 2014, 666 LVADs were implanted (age 54.5 ± 12.6 years. 77% men). Reoperation for bleeding was required in 22% of cases. Postoperative mortality was 13.2%. Over the decade, use of any blood products with LVAD surgery by year ranged from 83% to 100% (92 ± 5.3%). Intraoperative and postoperative blood products use was 71.8% and 73%, respectively. Only 7.4% of patients did not receive any blood products. Blood transfusion during surgery consisted of plasma (60%), platelets (56%), red blood cells (RBCs) (44.3%), and cryoprecipitate (32%), whereas after surgery RBC use was more frequent (68%). Compared with the initial 5 years (2005-2009), the units of blood transfused in the second 5 years (2010-2014) were significantly less, 21 ± 23 units vs. 16.6 ± 20.5 units, p = 0.0038. By multivariable analysis, preoperative factors predictive of blood transfusion are lower hematocrit, lower BMI, reoperative surgery, requirement for intraaortic balloon pump (IABP), and nonelective surgery. Blood transfusion with LVAD implantation remains very high. However, the amount of blood product transfused has decreased in the last 5 years.

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Update on Blood Conservation for Cardiac Surgery

Cited by 23 publications

References 236 publications

Cardiac Surgery-Associated Acute Kidney Injury

Cardiac Surgery-Associated Acute Kidney Injury

Blood Transfusion and Infection After Cardiac Surgery

Blood Product Utilization with Left Ventricular Assist Device Implantation: A Decade of Statewide Data

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